Circulation, Vol 68, 1304-1314, Copyright © 1983 by American Heart Association
I Kingma, JV Tyberg and ER Smith
Despite the clinical prevalence of paradoxic interventricular septal (IVS)
motion, its pathogenesis remains unclear. To assess the influence of the
end-diastolic transseptal pressure gradient, we studied eight open-chest
dogs during right ventricular (RV) volume loading (induced by opening a
Dacron shunt between the pulmonary artery [PA] and right atrium), RV
pressure loading (constriction of PA), and left bundle branch block (RV
pacing). Ultrasonic crystals in the IVS and on the RV and left ventricular
(LV) free walls (FW) allowed measurement of RV septal-to-free wall (S-FW)
and LVS-FW diameters. Another set measured the anteroposterior (AP)
diameter of the LV (LVAP). Two-dimensional and M mode echocardiograms
confirmed IVS shape and motion pattern, respectively. RV volume load caused
a reduction in mean transseptal end- diastolic pressure gradient from 2.1
to -2.6 mm Hg (p less than .001), with a concomitant increase in mean
end-diastolic RVS-FW diameter of 2.5 mm (p less than .001) and a decrease
in LVS-FW diameter of 2.8 mm (p less than .001). LVAP was unchanged.
Echocardiograms confirmed a leftward IVS shift during diastole with
paradoxic systolic motion. PA constriction and RV pacing caused similar
directional changes in transseptal end-diastolic pressure gradients and
diameters. Compared with control values, shunt opening and PA constriction
also caused a small leftward shift of IVS at end-systole. Normalized data
from all eight dogs revealed significant (p less than .001) correlations
between reduction in LV-RV end-diastolic pressure gradients and increases
in RVS-FW (r = .85) and decreases in LVS-FW (r = .80) diameters.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Effects of diastolic transseptal pressure gradient on ventricular septal position and motion
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